Black History Month gives us the opportunity to recognize Black Americans' contributions to our culture and society. It's an essential social observance, but merely witnessing history is inadequate. We must use our understanding of the past to create a promising future.
Remembering the hardship Black Americans have faced and commending the strength of the Black community calls on us to use this moment to generate momentum for personal and organizational growth beyond the month of February.
As healthcare institutions, providers, educators, students, and activists, we can translate our awareness into action that makes a real-world difference in Black health, Black health outcomes, and the Black healthcare experience.
Black History as Modern Legacy
The healthcare system has historically underserved Black Americans, contributing to health disparities and creating deeply rooted mistrust. While society has progressed immensely from the days of legal slavery and segregation, the legacy of that history continues to impact Black health and healthcare. Some examples include:
Experimentation
Many enslaved people endured medical experiments at the hands of medical educators and researchers. A prevailing notion during this period was that Black bodies experienced less pain than White bodies. This idea has influenced and persists in medical treatment today. Black Americans are consistently under-prescribed pain medications, and more than half of medical students and residents hold false beliefs about biological differences between Black and White people, including that Black people feel less pain.
Exclusion
Historically, Black Americans were excluded from the majority of medical clinics and hospitals and White medical schools. This made it difficult for Black people to acquire quality healthcare. A lack of Black doctors continues to impact Black health today. Evidence shows that when doctors and patients share a race and ethnicity, patient experience and outcomes are improved. Common racial and ethnic backgrounds enhance shared decision-making, medical adherence, patient understanding of risk, and perception of treatment plans. Shared race and ethnicity also reduce implicit bias on the part of providers.
Ethics
Black Americans have been subject to unethical medical practices dating from the period of enslavement. Oft-cited examples include involuntary sterilization, the Tuskeegee syphilis study, and the stealing of genetic material from Henrietta Lacks. But the existence of modern health disparities is also a bioethical issue. Differences in outcomes and burden of disease that result from racial and ethnic discrimination, implicit bias, research exclusion, access to health insurance, and social determinants of health are ethically unacceptable and must be addressed.
Mitigating Medical Mistrust
Medical mistrust refers to a lack of faith in the caring and competence of healthcare providers and institutions. In October 2020, seven out of 10 Black Americans said people are treated unfairly based on race or ethnicity when seeking medical care. This indicates deep mistrust that can translate to lower rates of preventative care, lack of participation in clinical trials, less adherence to medical advice, and a poor perception of care and services.
Building trust in the medical establishment is a social endeavor that will require policy changes to expand access and affordability of healthcare, among other big-picture changes. However, there are practical steps that individual providers and organizations can take to create more trusting doctor-patient relationships. (See our blog post, "3 Simple Ways to Alleviate Patient Mistrust.")
5-Step Action Plan
At the provider-level:
- Discuss trust issues and your patients' specific experiences with healthcare.
- Treat your patients as experts in their own health and wellness - ask what they understand is happening and how they'd like to approach treatment.
- Avoid jargon and other language that could be seen as patronizing.
- Use empathy, not arguments, to counter fears and remove barriers.
- Communicate your work to address implicit bias and build cultural competency.
At the organizational-level:
- Develop integrated staff and support teams that reflect your patients' racial and ethnic backgrounds.
- Include racially and ethnically diverse people in informational and marketing materials.
- Create opportunities for relationship-building outside of exam rooms.
- Partner with community organizations to promote health and wellness and encourage preventative care.
- Make provider cultural competency training a central part of your business diversity plan.
Quality Interactions offers accredited courses on implicit bias and cross-cultural communication skills to help healthcare providers navigate medical mistrust and provide an affirming healthcare experience for Black patients.
Soon we will be releasing a new course on Racial Health Equity to address issues of discrimination and systemic racism. Sign up for early access to this groundbreaking and timely new course.
